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Federal Free Printable 2018 Form 8962 for 2019 Federal Premium Tax Credit

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Premium Tax Credit
2018 Form 8962

Form 8962 OMB No. 1545-0074 Premium Tax Credit (PTC) Department of the Treasury Internal Revenue Service Name shown on your return ▶ 2018 ▶ Attach to Form 1040 or Form 1040NR. Go to www.irs.gov/Form8962 for instructions and the latest information. Attachment Sequence No. 73 Your social security number You cannot take the PTC if your filing status is married filing separately unless you qualify for an exception (see instructions). If you qualify, check the box Part I 1 2a b 3 5 6 . ▶ Annual and Monthly Contribution Amount Tax family size. Enter your tax family size (see instructions) . Modified AGI. Enter your modified AGI (see instructions) . . . . . . . . . . . . . . . . . Enter the total of your dependents’ modified AGI (see instructions) . . . Household income. Add the amounts on lines 2a and 2b (see instructions) . . . . . . . . . . . 2a 2b . . . . . . . 1 . . . . . 3 Federal poverty line. Enter the federal poverty line amount from Table 1-1, 1-2, or 1-3 (see instructions). Check the appropriate box for the federal poverty table used. a Alaska b Hawaii c Other 48 states and DC Household income as a percentage of federal poverty line (see instructions) . . . . . . . . . . . . Did you enter 401% on line 5? (See instructions if you entered less than 100%.) 4 . 4 5 % No. Continue to line 7. Yes. You are not eligible to take the PTC. If advance payment of the PTC was made, see the instructions for how to report your excess advance PTC repayment amount. 7 Applicable Figure. Using your line 5 percentage, locate your “applicable figure” on the table in the instructions 8a Annual contribution amount. Multiply line 3 by line 7. Round to nearest whole dollar amount Part II 9 . . b Monthly contribution amount. Divide line 8a by 12. Round to nearest whole dollar amount 8a 7 8b Premium Tax Credit Claim and Reconciliation of Advance Payment of Premium Tax Credit Are you allocating policy amounts with another taxpayer or do you want to use the alternative calculation for year of marriage (see instructions)? Yes. Skip to Part IV, Allocation of Policy Amounts, or Part V, Alternative Calculation for Year of Marriage. No. Continue to line 10. See the instructions to determine if you can use line 11 or must complete lines 12 through 23. Yes. Continue to line 11. Compute your annual PTC. Then skip lines 12–23 No. Continue to lines 12–23. Compute and continue to line 24. your monthly PTC and continue to line 24. 10 Annual Calculation 11 (a) Annual enrollment premiums (Form(s) 1095-A, line 33A) (b) Annual applicable SLCSP premium (Form(s) 1095-A, line 33B) (d) Annual maximum premium assistance (subtract (c) from (b), if zero or less, enter -0-) (c) Annual contribution amount (line 8a) (e) Annual premium tax (f) Annual advance credit allowed payment of PTC (Form(s) 1095-A, line 33C) (smaller of (a) or (d)) Annual Totals Monthly Calculation (a) Monthly enrollment (b) Monthly applicable premiums (Form(s) SLCSP premium 1095-A, lines 21–32, (Form(s) 1095-A, lines column A) 21–32, column B) (c) Monthly contribution amount (amount from line 8b or alternative marriage monthly calculation) (d) Monthly maximum (f) Monthly advance (e) Monthly premium tax premium assistance payment of PTC (Form(s) credit allowed (subtract (c) from (b), if 1095-A, lines 21–32, (smaller of (a) or (d)) zero or less, enter -0-) column C) 12 13 14 15 16 17 18 19 20 21 22 23 January February March April May June July August September October November December 24 Total premium tax credit. Enter the amount from line 11(e) or add lines 12(e) through 23(e) and enter the total here 24 25 Advance payment of PTC. Enter the amount from line 11(f) or add lines 12(f) through 23(f) and enter the total here 25 26 Net premium tax credit. If line 24 is greater than line 25, subtract line 25 from line 24. Enter the difference here and on Schedule 5 (Form 1040), line 70, or Form 1040NR, line 65. If line 24 equals line 25, enter -0-. Stop here. If line 25 is greater than line 24, leave this line blank and continue to line 27 . . . . . . . . . . . . . 26 Part III Repayment of Excess Advance Payment of the Premium Tax Credit 27 Excess advance payment of PTC. If line 25 is greater than line 24, subtract line 24 from line 25. Enter the difference here 27 28 Repayment limitation (see instructions) 28 . . . . . . . . . . . . . . . . . . . . . . Excess advance premium tax credit repayment. Enter the smaller of line 27 or line 28 here and on Schedule 2 29 (Form 1040), line 46, or Form 1040NR, line 44 . . . . . . . . . . . . . . . . . . . . For Paperwork Reduction Act Notice, see your tax return instructions. Cat. No. 37784Z 29 Form 8962 (2018) Form 8962 (2018) Part IV Page 2 Allocation of Policy Amounts Complete the following information for up to four policy amount allocations. See instructions for allocation details. Allocation 1 30 (a) Policy Number (Form 1095-A, line 2) Allocation percentage applied to monthly amounts (b) SSN of other taxpayer (e) Premium Percentage (c) Allocation start month (f) SLCSP Percentage (d) Allocation stop month (g) Advance Payment of the PTC Percentage Allocation 2 31 (a) Policy Number (Form 1095-A, line 2) Allocation percentage applied to monthly amounts (b) SSN of other taxpayer (e) Premium Percentage (c) Allocation start month (f) SLCSP Percentage (d) Allocation stop month (g) Advance Payment of the PTC Percentage Allocation 3 32 (a) Policy Number (Form 1095-A, line 2) Allocation percentage applied to monthly amounts (b) SSN of other taxpayer (e) Premium Percentage (c) Allocation start month (f) SLCSP Percentage (d) Allocation stop month (g) Advance Payment of the PTC Percentage Allocation 4 33 (a) Policy Number (Form 1095-A, line 2) Allocation percentage applied to monthly amounts 34 (b) SSN of other taxpayer (e) Premium Percentage (c) Allocation start month (f) SLCSP Percentage (d) Allocation stop month (g) Advance Payment of the PTC Percentage Have you completed all policy amount allocations? Yes. Multiply the amounts on Form 1095-A by the allocation percentages entered by policy. Add all allocated policy amounts and nonallocated policy amounts from Forms 1095-A, if any, to compute a combined total for each month. Enter the combined total for each month on lines 12–23, columns (a), (b), and (f). Compute the amounts for lines 12–23, columns (c)–(e), and continue to line 24. No. See the instructions to report additional policy amount allocations. Part V Alternative Calculation for Year of Marriage Complete line(s) 35 and/or 36 to elect the alternative calculation for year of marriage. For eligibility to make the election, see the instructions for line 9. To complete line(s) 35 and/or 36 and compute the amounts for lines 12–23, see the instructions for this Part V. 35 Alternative entries for your SSN 36 Alternative entries for your spouse’s SSN (a) Alternative family size (b) Alternative monthly contribution amount (c) Alternative start month (d) Alternative stop month (a) Alternative family size (b) Alternative monthly contribution amount (c) Alternative start month (d) Alternative stop month Form 8962 (2018)
Extracted from PDF file 2018-federal-form-8962.pdf, last modified November 2018

More about the Federal Form 8962 Other TY 2018

We last updated the Premium Tax Credit in December 2018, so this is the latest version of Form 8962, fully updated for tax year 2018. You can download or print current or past-year PDFs of Form 8962 directly from TaxFormFinder. You can print other Federal tax forms here.

Other Federal Other Forms:

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Form 8962 Premium Tax Credit
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Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 8962 from the Internal Revenue Service in December 2018.

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Historical Past-Year Versions of Federal Form 8962

We have a total of five past-year versions of Form 8962 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2018 Form 8962

2018 Form 8962

2017 Form 8962

2017 Form 8962

2016 Form 8962

2016 Form 8962

Premium Tax Credit (PTC) 2015 Form 8962

2015 Form 8962

Premium Tax Credit (PTC) 2014 Form 8962

2014 Form 8962


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